Heinz Leipold

Does the mode of delivery influence sexual function after childbirth

OBJECTIVE The aim of the study was to evaluate the influence of the mode of delivery on female sexuality 12-18 months after childbirth. METHODS Fifty-five primiparae who delivered vaginally without complication and 44 who underwent elective cesarean section after 37 weeks of gestation were included. Sexual function was assessed by a validated self-reported questionnaire, the Female Sexual Function Index (FSFI), 12 months after birth and compared between groups. Additionally, we have analyzed subjective stress variables recorded after birth between the two groups. RESULTS Women with cesarean section were older (p = 0.002) and had a higher body mass index (BMI) (p =0.02). The total score of the FSFI was not significantly different between the groups. Patients recall of dyspareunia at 3 months after childbirth was higher in those who underwent vaginal delivery (p < 0.001). CONCLUSIONS We suggest that there is no significant difference in sexual function 12-18 months after childbirth between women who delivered vaginally without episiotomy, heavy perineal laceration, or secondary operative interventions and women who underwent elective cesarean section.

Prevalence of Cervical and Intrauterine Human Papillomavirus Infected in the Third Trimester in Asymptomatic Women

Objective: To study the prevalence and association of human papillomavirus (HPV) infection in the cervix of pregnant women without visible signs of genital HPV infection undergoing cesarean delivery in the third trimester and to investigate a possible HPV transmission to the fetus. Methods: All women underwent cesarean delivery between 37 and 40 weeks of gestation. Cervical samples were taken prior to cesarean delivery. Furthermore, amniotic fluid, placental tissue, and cord blood were sampled and polymerase chain reaction (PCR) or Hybrid Capture II test (Digene Corp, Beltsville, MD) was performed to detect HPV DNA. Results: We found that 56 (36.6%) of 153 women were positive for HPV in the cervix. Logistic regression analyses showed a decrease of prevalence of HPV infection with increasing maternal age (P = .02). No HPV DNA could be detected in the amniotic fluid or cord blood, whereas eight placental specimens were positive for HPV DNA. Conclusion: The infection rate in women without clinical symptoms of HPV infection is high, but there was no HPV found in the amniotic fluid and in cord blood in women with subclinical infection in the third trimester.

Gestational diabetes mellitus is associated with increased C-reactive protein concentrations in the third but not second trimester

Objective Serum C‐reactive protein (CRP) concentrations were measured longitudinally throughout pregnancy to test the hypothesis that CRP could relate more closely to glucose tolerance than to adiposity.

Calpain-10 haplotype combination and association with gestational diabetes mellitus.

OBJECTIVE: Gestational diabetes mellitus (GDM) is a frequent complication of pregnancy. Epidemiologic and pathophysiologic data suggest a close link of this disease to non-insulin-dependent diabetes mellitus. Within the calpain-10 gene various single-nucleotide polymorphisms have been identified that increased the risk for non-insulin-dependent diabetes mellitus. Therefore, we examined single-nucleotide exchanges of this gene in women with GDM. METHODS: A total of 875 unselected women were prospectively screened for GDM. Eighty women of this population, 40 patients with an abnormal oral glucose tolerance test and 40 normal controls, were randomly selected. DNA samples isolated from sera of the control and study groups were analyzed with respect to single-nucleotide polymorphisms of the calpain-10 gene at positions 43, 19, and 63 using polymerase chain reaction amplification and restriction analysis. RESULTS: Women with GDM were more likely to be homozygous for the allele 1 of single-nucleotide polymorphism 63 (P = .02 by χ2 test). With respect to single-nucleotide polymorphisms 19 and 43, no significant differences in allele distribution were detected between controls and women with GDM. When comparing the different haplotypes for calpain-10 (single-nucleotide polymorphisms 43, 19, and 63), all women with the haplotype combination 121/221 (n = 8) had gestational diabetes (P = .005 by Fisher exact test). CONCLUSION: Our results indicate that the haplotype 121/221 of the calpain-10 gene may be associated with disturbances of glucose metabolism during pregnancy. LEVEL OF EVIDENCE: II-1

Plasminogen activator inhibitor 1 gene polymorphism and gestational diabetes mellitus.

OBJECTIVE: Plasminogen activator inhibitor 1 is thought to play a role in the pathogenesis of obesity and insulin resistance. Therefore, we examined a single nucleotide exchange in this gene in women with gestational diabetes mellitus. METHODS: A total of 887 unselected women were prospectively screened for gestational diabetes mellitus by oral glucose testing between the 24th and 28th weeks of gestation. Eighty white women of this collective, 40 patients with a pathological oral glucose tolerance test and 40 normal control subjects, were randomly selected. DNA samples were isolated from the sera and analyzed for the functional −675 4G/5G promotor polymorphisms of the plasminogen activator inhibitor 1 gene. RESULTS: Women with gestational diabetes mellitus were significantly older and had a significantly higher body mass index (BMI) than those who did not have gestational diabetes mellitus. Women with normal glucose tolerance were significantly more often homozygous for the 5G allele (P = .01), independently of maternal age or BMI. Low fasting glucose values in the oral glucose tolerance test were significantly related to homozygosity for 5G (P = .02). CONCLUSION: Homozygosity for the 5G allele of the plasminogen activator inhibitor 1 gene is associated with normal glucose tolerance in pregnant women. These findings further support a possible role of plasminogen activator inhibitor in the development of gestational diabetes mellitus. LEVEL OF EVIDENCE: II-2

Peroxisome Proliferator-Activated REceptor γ Coactivator-1α Gene Variations Are Not Associated With Gestational Diabetes Mellitus

Objective: Epidemiologic, pathophysiologic, and genetic data suggest a close link between gestational diabetes mellitus (GDM) and type 2 diabetes. Previous studies yielded controversial results on the impact of peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1) gene variations on the development of type 2 diabetes mellitus. Therefore, we examined two common single nucleotide polymorphisms (SNP) of this gene in women with GDM. Methods: We assesed a total of 875 women by oral glucose tolerance testing (OGTT). Two hundred women of this population, 100 patients with an abnormal OGTT and 100 normal controls, were randomly slected. DNA samples isolated from the blood of the control and study groups were analyzed with respect to the SNP Gly482Ser and Thr394Thr of the PGC-1 gene using polymerase chain reaction (PCR) amplification and restriction analysis. Furthermore, a potential interaction between the Gly482Ser and the Thr394Thr variant on the risk of GDM was investigated. Results: Women with GDM were significantly older (32.2 ± 5.5 years vs 29.7 ± 6.1 years; P = .005), had higher body mass indices (BMI; 28.0 ± 7.1 kg/m2 vs 25.0 ± 5.7 kg/m2; p = .002) and displayed higher memoglobin A1c (HbA1c) values (5.6 ± 0.9 vs 4.9 vs 4.9 ± 0.5; P <.001). There was no significant difference between the allele distribution of the two polymorphisms in women with and without GDM. No significant associations between the two polymorphisms and BMI or OGTT values were observed. When the different haplotype combinations of the two loci were analyzed for the risk of GDM, on significant association could be found. Conclusion: Based on our data, the Gly-482Ser and the Thr394Thr polymorphisms of the PGC-1 gene are not associated with the development of GDM.

Postoperative gum chewing after gynecologic laparoscopic surgery: a randomized controlled trial.

OBJECTIVE: To investigate the effect of postoperative gum chewing on bowel motility after laparoscopic gynecologic surgery. METHODS: In this randomized controlled trial, patients were allocated to either postoperative gum chewing every 2 hours for 15 minutes or standard postoperative care without gum chewing. The studys primary end points were time to first regular bowel sounds and time to first passage of flatus after surgery. Secondary end points were time of operation to first defecation, patient satisfaction concerning postoperative gum chewing, potential side effects of postoperative gum chewing, and potential effect of gum chewing on postoperative pain therapy. RESULTS: One hundred seventy-nine patients were included in this trial. We found a significantly shorter interval between surgery and passage of first flatus in the intervention group compared with the control group (median 6.2 hours compared with 8.1 hours; P=.002) and a significantly higher rate of regular bowel sounds 3 hours (76% compared with 47%; P<.001) and 5 hours (91% compared with 78%; P=.01) after surgery. Fewer opioid analgetics were administered to patients allocated to the intervention group (P=.02). There was no significant difference in time to first defecation between groups (median 26.3 hours compared with 29.0 hours, P=.165). Gum chewing was well tolerated and well accepted by patients, and no intervention-related side effects were observed. CONCLUSION: Gum chewing seems to have beneficial effects on bowel motility when used as an adjunct treatment in postoperative care after minimally invasive surgery. Gum chewing should be recommended to patients after gynecologic laparoscopic surgery. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov, NCT 01549353. LEVEL OF EVIDENCE: I

Retinol-binding protein 4 in patients with gestational diabetes mellitus.

OBJECTIVE It is still unknown if serum retinol-binding protein 4 (RBP4) relates to metabolic control and the occurrence of gestational diabetes mellitus (GDM). We studied RBP4 levels in patients with insulin-treated GDM and healthy pregnant women twice during pregnancy. METHODS Sixty-three women with GDM and 38 healthy pregnant women were included. Serum RBP4 levels were measured at 24-28 weeks of gestation and 8 weeks later. Patients with GDM were treated with insulin. RESULTS Serum RBP4 levels increased significantly between the two measurements in patients with GDM (p = 0.03). In patients with GDM, RBP4 concentrations at 33 weeks of gestation correlated positively with mean blood glucose, hemoglobin A1c values, and cord blood insulin values right after delivery. Regression analyses showed that the diagnosis of GDM (p = 0.04) and hemoglobin A1c levels (p < 0.001) were related to RBP4 levels at 33 weeks of gestation. CONCLUSIONS Serum RBP4 levels increase during pregnancy in patients with insulin-treated GDM.

Transcription factor 7-like 2 gene polymorphisms and gestational diabetes mellitus

Objective: Transcription factor 7-like 2 (TCF7L2) gene polymorphisms were shown to be associated with insulin resistance. We examined two single nucleotide exchanges in this gene in women with gestational diabetes mellitus (GDM) and in women with normal glucose tolerance. Methods: A total of 1800 unselected women were prospectively screened for GDM by oral glucose tolerance test (OGTT) between 24 and 28 weeks of gestation. Two hundred and fifty Caucasian women of this collective, 125 patients with pathological OGTT and 125 patients with normal glucose tolerance were randomly selected. DNA samples were isolated and TCF7L2 gene polymorphisms (TCF7L2rs12255372 and TCF7L2rs7903146) were analyzed. Results: Women with GDM were significantly older (30.1 ± 3.4 years vs. 28.2 ± 4.8 years, p = 0.01), had a significantly higher body mass index (26.4 kg/m2; interquartile range: 23.33–31.19 vs. 24.6 kg/m2; interquartile range: 21.05–27.28, p = 0.02) and were significantly more often homozygous for the T allele of TCF7L2rs12255372 (17.2% vs. 2.6%, p = 0.002) than patients with normal glucose tolerance. Binary logistic regression analysis showed that the homozygous variant of TCF7L2rs12255372 (T/T) is an independent risk factor for GDM (OR 7.7, 95% CI: 1.71–34.60), but not the homozygous variant of TCF7L2rs7903146 (T/T). Conclusions: TCF7L2rs12255372 variant (T/T) is associated with increased risk of GDM in Caucasian women.

Interleukin-1 beta gene polymorphisms and preterm birth

OBJECTIVE To investigate the association between two genetic variations in the Interleukin-1 beta (IL1B) gene and preterm birth. STUDY DESIGN In this case-control study we tested the allelic distribution of two of its common polymorphisms (IL1B +3953C>T [rs1143634], IL1B -511C>T [rs16944]) in one hundred women with preterm birth and one hundred healthy women with at least one uncomplicated full term pregnancy and no history of preterm birth. RESULTS A significant association was found between the presence of the IL1B +3953C>T polymorphism and preterm birth (p=0.049, OR 0.6 [0.3-1.0]). No significant association was found between the IL1B -511C>T polymorphism and preterm birth (p=0.471, OR 1.3 [0.7-2.3]). CONCLUSION Our findings suggest that the IL1B +3953C>T polymorphism is associated with a risk reduction for preterm birth in Caucasian women, possibly by altering the inflammatory response during pregnancy.